An investigation into the effects of a posterior-to-anterior lumbar mobilisation technique on neurodynamic mobility in the lower limb

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Authors
Wood, Lewis
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Degree
Master of Osteopathy
Grantor
Unitec Institute of Technology
Date
2008
Supervisors
Moran, Robert
Nash, Derek
Type
Masters Dissertation
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
spinal mobilisation
manual therapy
peripheral nervous system
straight leg raise test
passive knee extension test
hamstring muscle length
Citation
Wood, L. (2008). An investigation into the effects of a posterior-to-anterior lumbar mobilisation technique on neurodynamic mobility in the lower limb. Unpublished thesis submitted in partial fulfillment of the degree of Master of Osteopathy, Unitec Institute of Technology, New Zealand.
Abstract
Background and Objectives: Spinal mobilisation is commonly used in the field of manual medicine to address lumbar joint dysfunction. In addition, lumbar mobilisation has been proposed as a method to improve lower limb neurodynamic mobility, however, there is no published research to support this hypothesis. The aim of this study was to evaluate the effect of a posterior-to-anterior lumbar mobilisation technique on straight leg raise (SLR) and passive knee extension (PKE). Methods: A randomised controlled experiment was conducted. Male participants (n=23) were recruited and randomly allocated to receive a posterior-to-anterior L4/L5 lumbar mobilisation or a sham technique. Additional male participants (n=12) were recruited into a control group. The main outcome measures used to represent lower limb range of motion were SLR and PKE tests; neck flexion (NF) was used as a structural differentiation test to reduce neurodynamic mobility for each measure. Results: The experimental intervention demonstrated a ‘very large’ effect (d=2.14) on increased pre-post SLR measurements and a ‘large’ effect (d=1.6) on SLRNF when compared with the control group. The sham intervention was associated with similar improvements, demonstrating a ‘large‘ effect for both pre-post SLR (d=1.7) and SLRNF (d=1.3) ranges. Analysis between experimental, sham and control groups showed a significant increase for pre-post ranges of SLR (p<0.001) and SLRNF (p=0.003). Pre-post ranges of PKE were not affected by either intervention (p=0.36). Immediate improvements in range of SLR (p<0.01) and SLRNF (p<0.04) following the application of the lumbar mobilisation or sham technique were not evident after a 48-hour follow-up period. The addition of neck flexion as a structural differentiation test demonstrated a ‘trivial’ effect on pre-post ranges of SLR versus SLRNF (d<0.16) for all intervention groups. Conclusion: A posterior-to-anterior lumbar mobilisation technique applied to the L4/L5 vertebrae improved neurodynamic SLR and SLRNF mobility, with minimal effect on PKE measurements, however, the sham technique demonstrated similar results. A placebo effect is discussed to explain these comparative findings. These observed improvements are not attributable to the engagement of joint articulation applied at a putative neural convergence point in the lumbar spine. The application of the L4/L5 PA lumbar mobilisation and sham technique increased lower limb neurodynamic mobility in asymptomatic male participants. NB. The results of this research have been published online at sportEX magazine, Background and Objectives: Spinal mobilisation is commonly used in the field of manual medicine to address lumbar joint dysfunction. In addition, lumbar mobilisation has been proposed as a method to improve lower limb neurodynamic mobility, however, there is no published research to support this hypothesis. The aim of this study was to evaluate the effect of a posterior-to-anterior lumbar mobilisation technique on straight leg raise (SLR) and passive knee extension (PKE). Methods: A randomised controlled experiment was conducted. Male participants (n=23) were recruited and randomly allocated to receive a posterior-to-anterior L4/L5 lumbar mobilisation or a sham technique. Additional male participants (n=12) were recruited into a control group. The main outcome measures used to represent lower limb range of motion were SLR and PKE tests; neck flexion (NF) was used as a structural differentiation test to reduce neurodynamic mobility for each measure. Results: The experimental intervention demonstrated a ‘very large’ effect (d=2.14) on increased pre-post SLR measurements and a ‘large’ effect (d=1.6) on SLRNF when compared with the control group. The sham intervention was associated with similar improvements, demonstrating a ‘large‘ effect for both pre-post SLR (d=1.7) and SLRNF (d=1.3) ranges. Analysis between experimental, sham and control groups showed a significant increase for pre-post ranges of SLR (p<0.001) and SLRNF (p=0.003). Pre-post ranges of PKE were not affected by either intervention (p=0.36). Immediate improvements in range of SLR (p<0.01) and SLRNF (p<0.04) following the application of the lumbar mobilisation or sham technique were not evident after a 48-hour follow-up period. The addition of neck flexion as a structural differentiation test demonstrated a ‘trivial’ effect on pre-post ranges of SLR versus SLRNF (d<0.16) for all intervention groups. Conclusion: A posterior-to-anterior lumbar mobilisation technique applied to the L4/L5 vertebrae improved neurodynamic SLR and SLRNF mobility, with minimal effect on PKE measurements, however, the sham technique demonstrated similar results. A placebo effect is discussed to explain these comparative findings. These observed improvements are not attributable to the engagement of joint articulation applied at a putative neural convergence point in the lumbar spine. The application of the L4/L5 PA lumbar mobilisation and sham technique increased lower limb neurodynamic mobility in asymptomatic male participants. NB. The results of this research have been published online at sportEX magazine, available at http://content.yudu.com/A1rorp/27DY10-14/
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